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Call for caution on donor consent

NSW government flags proposal to remove family veto on organ donation, Natasha Egan reports.

A proposal to remove a family member’s right to override their relative’s organ donation consent has drawn opposition from health professionals.

The suggestion was one of many in a discussion paper launched in early December by the NSW Health Minister Jillian Skinner aimed at improving donor rates in NSW.

Consent was overruled in about half of all eligible situations in the state last year so “perhaps it is time to look at ensuring patients have the final say”, Skinner said.

The call was backed by Transplant Australia national chairman Dr Alan Amodeo, but NSW Nurses Association general secretary Brett Holmes urged caution.

“Medical professionals do have to make some very difficult decisions but making them in the face of clear opposition of relatives would make it untenable,” Holmes told Nursing Review

It could lead to aggressive or violent behaviour from family members who might think they are saving their relative’s life, he said. “The consequence is that they make serious complaints either of a criminal nature or of a professional nature, which even if they’re not founded, would cause enormous distress and concern for the person’s involved.”

Assistant professor of critical care nursing at the University of Canberra Holly Northam said such a policy would have significant consequences for the acceptance of organ donation. “We have a difficult time as it is in creating an environment of trust around organ donation and that would really be quite damaging,” Northam told ***NR***.

She said it was important to look at the reasons why families said no, because there was something happening from their perspective that was not understood. This is Northam’s area of PhD research.

Other proposals in the discussion paper included enhancing the living donor program, boosting donations within Aboriginal and cultural and linguistically diverse (CALD) communities and changes to the donation register, such as a model of presumed consent.

NSW has one of the lowest donation rates in the country at 12.4 per million population, compared with 19.7 in Tasmania.
The NSW Nurses Association supported the proposition that more was needed to be done on Advanced Care Directives, which could be used in the absence of registered consent, Holmes said.

Kidney Health Australia’s national medical director Tim Mathew welcomed the proposals for enhancing the living donor program.

Holmes also agreed and welcomed the proposals to provide donors with paid leave, travel and accommodation support.

However, Northam questioned whether it would be preferable to work on maximising donation after death because of the risks that come from the operation.

“As a nurse who has worked with patients who have been involved in donating in the living donor program I am concerned that we possibly don’t always protect them from harm enough,” she said.

Northam said discussions around simplifying the consent process were very valuable and scrapping the RTA database in favour of the national register was positive because having two databases was confusing for the public.

Further it can be problematic for health professionals, especially when accessing records when a death occurs out-of-state, she said.
Support for moving to the national system was echoed by Transplant Australia and ShareLife.

Regarding the section in the discussion paper on Aboriginal and CALD communities, Holmes said the union supported cultural awareness training and using designated requestors of the appropriate cultural backgrounds.

However, the section on delegating next of kin functions is an area of concern “in that there needs to be a clear understanding of those delegations and what authority they have”, he said.

Northam said the concept of having local champions across all the different groups to offer support and accurate information was helpful and could make things easier for family members.

But it is important to normalise organ donation for every family in every death so wishes around organ and tissue donation become a regular conversation, she said.

Elsewhere, the NSW police and health departments have announced a new process for organ delivery. From January, a shared system will provide one point of call to get the process started, which is expected to save lives.

Submissions to the discussion paper can be made to NSW Health before January 31.

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